In plain terms: Pneumatic Lymphatic Compression has some human trial evidence supporting it, but the evidence is not yet strong enough for EBL to call it established. It is worth knowing about and worth discussing with your clinician.
Pneumatic Lymphatic Compression
The evidence as the record states it
O'Donnell et al. (Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2026; PMID 41997536): systematic review of contemporary randomized trials of intermittent pneumatic compression in clinical lymphedema. Grade B rests on this review and on the limb-volume endpoint alone. The two Maia trials (PMIDs 39416507 and 40555415) are sports-recovery studies in athletes; they carry the separate Grade D on exercise recovery and are not evidence for the lymphedema letter.
Evidence by specific use
Why Grade B and not Grade A
Grade B reflects moderate human evidence -- typically a single strong trial, multiple smaller trials, or surrogate endpoint data without hard clinical outcome replication. To reach Grade A, Pneumatic Lymphatic Compression would require at least one additional independent randomized trial demonstrating a hard clinical endpoint or objectively measured functional outcome in a comparable population.
What this grade covers and what it does not
What would move this grade
An independent randomized trial demonstrating a hard clinical endpoint -- mortality, major adverse event, or objectively confirmed functional improvement -- in an adequately powered sample, with results independently replicated, would support Grade A.